Organization
LEGACY MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINA MOSLEY-CARTER (EXECUTIVE DIRECTOR)
(801) 833-0000
Entity
Organization
Contact information
Practice address
1020 W ATHERTON DR, SUITE 220, TAYLORSVILLE, UT 84123-3470
(801) 833-0000
(801) 833-0001
Mailing address
1020 W ATHERTON DR, SUITE 220, TAYLORSVILLE, UT 84123-3470
(801) 833-0000
(801) 833-0001
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/14/2015
Last updated
11/09/2015
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